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Women’s Acceptance of Overdetection in Breast Cancer Screening: Can We Assess Harm-Benefit Tradeoffs?

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  • Anne Stiggelbout

    (Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands)

  • Tessa Copp

    (Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia)

  • Gemma Jacklyn

    (Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia)

  • Jesse Jansen

    (Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia)

  • Gerrit-Jan Liefers

    (Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands)

  • Kirsten McCaffery

    (Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia)

  • Jolyn Hersch

    (Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia)

Abstract

Background. Breast cancer screening has been presented to women as mostly positive for decades, despite voices raising issues related to harms since its introduction. Public communications about breast cancer screening tended to use persuasive techniques aimed at maximizing uptake. Concern about the harm of overdetection is more recent, and awareness of overdetection among the public is limited. We aimed to assess the impact of extensive information on treatment following overdetection in breast screening on women’s acceptance of screening, and to assess correlates of acceptance. Methods. We performed an online survey among women aged 45-75 from the general public in the Netherlands and Australia, asking women their maximum acceptable ratio of overdetection, per breast cancer death avoided, for four treatment scenarios (randomized order): mastectomy; lumpectomy; lumpectomy plus radiotherapy; lumpectomy plus radiotherapy and hormone therapy. The effect of treatment was assessed using General Linear Models, controlling for socio-demographics, experience, and psychological characteristics. Results. Four-hundred Australian and 403 Dutch women responded. Around half of the women would always screen, even at a 6:1 overdetection-to-death-avoided ratio. Acceptance was highest for the lumpectomy scenario, decreasing with more invasive treatment. In multivariate analyses the effect of treatment remained (p

Suggested Citation

  • Anne Stiggelbout & Tessa Copp & Gemma Jacklyn & Jesse Jansen & Gerrit-Jan Liefers & Kirsten McCaffery & Jolyn Hersch, 2020. "Women’s Acceptance of Overdetection in Breast Cancer Screening: Can We Assess Harm-Benefit Tradeoffs?," Medical Decision Making, , vol. 40(1), pages 42-51, January.
    • Handle: RePEc:sae:medema:v:40:y:2020:i:1:p:42-51
    DOI: 10.1177/0272989X19886886
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    References listed on IDEAS

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    1. Ray Moynihan & Brooke Nickel & Jolyn Hersch & Elaine Beller & Jenny Doust & Shane Compton & Alexandra Barratt & Lisa Bero & Kirsten McCaffery, 2015. "Public Opinions about Overdiagnosis: A National Community Survey," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
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